Presenting author biography:

General practionner dedicating most of her practice to injecting drug users (CRAN, UHRESS CHUM). Master in public health on supervised injection sites implementation in Montreal. University director at the internship «health inequalities and social role of doctors» at University of Montreal.
Board member: Doctors of the world, CSAM

OST programs: how can we lower the treshold?

Marie-Eve Goyer, Elaine Polflit

Created in 1986, the CRAN (Centre de recherche et d'aide pour les narcomanes) is an expertise center for research and treatment of opioid addiction in Montreal made of regular and low treshold services. The Relais low threshold service has been offering treatment to highly vulnerable individuals since 1999. Every year, 250 patients, 70% males in their early 40s, are seen at the clinic. These patients are mostly polysubstance users with a diagnostic of mental illness and struggling with homelessness or housing instability.

Always trying to reach the most vulnerable opioid addicted patients, the CRAN has undertaken a reflexion since 2014 on how to increase access and lower barriers to OST. Lisbon Ares do Pinhal and Paris Gaia initiatives were visited and a major consultation was done within our users and partners.

This ongoing clinical reflexion has lead the clinical team to explore complementary approches that would facilitate both access to and retention in OST. Modifying the clinic's structure, services and opening hours to increase accessibility, offering animal assisted therapy and creating strong partnership with community organisations are strategies that will be core to the clinic's evolution toward an even lower threshold. But above all these recommendations, it appears clearly that the first one to implement would be the involvement and recognition of peers. Peers should be involved as active members of the OST team, but also outside the OST clinic in order to serve as multiplying agents and referents for the most vulnerable users.